Abstract
BackgroundTo understand geographic variation in access to care over time in patients with kidney disease.MethodsWe analyzed 4404 (weighted sample of 4,251,129) adults with kidney disease from the United States using the Medical Expenditure Panel Survey over 10 years. Three dependent variables were created to investigate variation in access: usual source of care, overall medical access to care, which took into account usual source of care, ability to get care, and delay in care, and prescription access, which took into account ability to get prescriptions and delay in getting prescriptions. Multiple logistic regression was used with geographic region as the main independent variable, adjusting for relevant covariates.ResultsCompared to the Northeast region, adults living in the Midwest (OR = 0.56; 95 % CI 0.35–0.89), South (OR = 0.48; 95 % CI 0.32–0.72) and West (OR = 0.53; 95 % CI 0.34–0.84) had significantly lower odds of reporting usual source of care. For the combined access measure, compared to Northeast, adults in Midwest (OR = 0.60; 95 % CI 0.40–0.88), South (OR = 0.62; 95 % CI 0.44–0.88) and West (OR = 0.50; 95 % CI 0.34–0.72) had significantly lower odds of medical access to care. Region was not significantly associated with the odds of having prescription access, though a significant increase in prescription access was observed over time.ConclusionsGeographic variation in access to care among adults with kidney disease exists independent of income, education, insurance and comorbid conditions, with those in the South least likely to have a usual source of care and those in the West least likely to have overall access to care when compared to the Northeast United States.
Highlights
To understand geographic variation in access to care over time in patients with kidney disease
Of the sample population representing 4404 U.S adults with kidney diseases (KD), 15.5 % were from Northeast, 19.7 % were from Midwest, 42.5 % were from South and the remaining 22.3 % were from the West region
Non- Hispanic Whites with KD were more likely in the Midwest region (83.2 compared to 73.6 % mean), Non-Hispanic Blacks with KD were more likely in the South region (14.4 compared to 11.3 % mean), and Hispanic and Others with KD were more likely in the West region (22.9 compared to 11.1 % mean for Hispanics, and 9.1 compared to 4.0 % mean for Other) (p < 0.001)
Summary
To understand geographic variation in access to care over time in patients with kidney disease. While actual access can be gauged by health care utilization information, measures gathering information on the ability to receive care when it is needed may be more appropriate [2, 3]. Global measures of access, such as having a primary care provider, ability to obtain care when needed, or delay in needed medical care, help evaluate overall access to care over time [3]. Investigations note inequity in access for low-income and minority populations including irregular source of care, lack of preventative care, and delay in obtaining needed care [3, 4]. Fewer studies investigate regional differences in care. As region is an immutable personal factor in healthcare, variations in this measure offer insight on system-level factors that may need targeted interventions [2].
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
